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THE THERAPY ROOM: Dementia and caregiving

Posted on 19 April 2018 by LeslieM

Part 2 of a 3-part series on dementia

Today, there are more than 9.9 million people caring for someone with Alzheimer’s and other dementia. Last month, the initial column in our series on dementia discussed dementia as a progressive biological brain disorder that makes it difficult for those diagnosed to think and communicate clearly and to even take care of themselves. This month, in part two of our series, we discuss practical strategies for caregivers who manage others with dementia.

Many families find it difficult and frustrating to communicate with a loved one with dementia. It is important to remember that a person with dementia cannot control behavior caused by their dementia.

Here is a list of common dementia behaviors and helpful suggestions for caregivers:

Eating and Nutrition: People with dementia forget their need to eat and drink, and complicating this may be dental problems, weight loss, irritability, disorientation, poor sleep and even bladder issues. Caregivers should consider serving meals away from a television and other distractions. Being flexible with food and beverage choices helps — a person with dementia may suddenly develop new food choices or reject ones that were liked in the past.

Bathing: Forgetting proper hygiene, such as bathing, combing hair, brushing teeth and changing clothes are common among people with dementia. Being cleaned by another person can be frightening, embarrassing and humiliating to a person being cared for and frustrating to a caregiver. If your loved one is modest when it comes to bathing, acknowledge that by making sure doors and shower curtains are closed. Keep a towel over private body parts and have a robe ready after bathing. Never leave a person with dementia unattended in a bath or shower and have all necessary bathing products in place for ease of use.

Sleeplessness: Restlessness and disorientation are troubling behaviors people with dementia experience and often it gets worse at the end of the day and throughout the night. Caregivers can increase daytime activities and discourage daytime naps, limit intake of sugar and caffeine and, if needed, consider speaking with patient’s physician about medication for sleeping issues.

Hallucinations and delusions: Seeing or hearing things others do not and false beliefs may occur as dementia progresses. Caregivers can offer reassurance and acknowledge the thoughts and feelings relating to hallucinations and delusions and use distractions to help such as suggesting a walk or simply moving to another room.

Caregivers at times forget to focus on their own needs.

Here are self care practices to consider:

Learn and use stress reduction techniques, such as exercise or yoga

Get rest and proper nutrition

Seek and accept support from others

Talk to other family members and the dementia patient’s physician about new concerns and seek their guidance for suggestions on additional or alternative care-giving assistance

A caregiver cannot stop the impact of dementia for someone they care for, but there is a great deal they can do to take responsibility for their own well-being and to have their needs met. When a caregiver’s needs are addressed the person being taken care of will benefit as well.

Dr. Julia Breur is a licensed marriage and family therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.

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The Therapy Room: Defining dementia part 1

Posted on 15 March 2018 by LeslieM

(Part one of a three part series) Dementia means “deprived of mind” and has been described in older adults since ancient times. Dementia is a term used for a wide range of symptoms that are severe enough to interfere with a person’s ability to perform everyday activities. These symptoms include the following:

Decline in memory

Language and communication confusion

Difficulty focusing and paying attention

Poor reasoning and
judgment

Difficulty with visual perception

The most common type of dementia is Alzheimer’s and is named after Alois Alzheimer, a German physician who first described it. Today, Alzheimer’s accounts for approximately 70 percent of the dementia cases. It causes problems with memory, thinking and behavior. Alzheimer’s is not a normal part of aging. The majority of people with Alzheimer’s are 65 or older and it is interesting to note that up to 5 percent of people with Alzheimer’s are in their 40s and 50s.

The second most common form of dementia is Vascular and this can occur after a person experiences a stroke. There are numerous other conditions that have symptoms of dementia, even some that are reversible, and include thyroid issues and vitamin deficiencies.

There is not one test to determine if someone has dementia. Physicians take into consideration medical history, physical examination, laboratory tests, mental and memory testing, changes in thinking, daily functioning and behaviors in order to determine that an individual has dementia.

10 Early Symptoms of Dementia

1. Memory Changes: Forgetting where an item has been left, struggling to know the name of someone in the same room or forgetting what given tasks are to be attended to in a given day

2. Difficulty with Words: Difficulty explaining a situation

3. Mood Changes: Mood changes, such as depression or a shift in personality, such as normally being shy to being very outgoing

4. Apathy: Losing interest in a normal activities or hobbies. Choosing to be alone rather than being socially interactive

5. Difficulty with Tasks: Difficulty balancing a checkbook or understanding players or score of sports game. Struggle to learn new things or follow new routines

6. Confusion: Confusion may occur since an individual can no longer remember faces, find right words or properly interact with others

7. Difficulty with Conversations: Struggle with comprehension during a conversation

8. Direction Disruption: Spatial orientation and sense of direction deteriorate. Following step by step instructions becomes difficult

9. Repetitive Behavior: Repeats daily tasks, repeats same question even after an answer has been provided

10. Change in routine can be difficult: Fear from memory loss — going for a walk and not knowing where one is within minutes. This may create desire to stick with what is known and not trying new things

Some risk factors for dementia, such as age and genetics, cannot be changed. Researchers continue to explore the impact of other brain risk factors and the prevention of dementia. Some active areas of research are in risk reduction and prevention of dementia to include application of the Mediterranean diet that appears to help protect the brain and physical fitness to increase blood and oxygen flow to the brain. Cardiovascular factors also help, such as not smoking, keeping blood pressure stable, monitoring cholesterol, monitoring blood sugar and maintaining a healthy weight.

Research over the past 20 years has greatly improved our understanding of what dementia is and how it develops and affects the brain. This work is paying off with better diagnostic techniques, improved treatments and potential ways of preventing these diseases.

For the next part in my three part series on Dementia, I will be focusing on Dementia and caregivers.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information is available at www.drjuliabreur.com.

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THE THERAPY ROOM: Relationships, Boundaries and Codependency

Posted on 15 February 2018 by LeslieM

This month, we celebrate Valentine’s Day as a significant cultural, religious and commercial reflection of romantic love.

As a practicing clinical psychotherapist, I meet with many couples who tell me that their romantic love has dwindled or even disappeared and they want my counseling to help them get back to feeling and expressing the love they experienced when they first met.

To recreate or restore a past romantic period to the present time is difficult, if not impossible, but, as a psychotherapist, I do help couples retrace the disappearance of their romantic love and help them rekindle it. I ask each partner to observe and discuss love as it relates to them individually and jointly. I usually get a confused look from the couple when I ask each to observe the love they have for self. I am not talking about narcissism, the insatiable need for constant attention and admiration, but I am talking about healthy love and care for oneself. Healthy love and care for oneself is part of the formula to be able to love another person.

Start with self love and self care. Take care of your own needs then serve others from that place of care and abundance. This way you will be giving the best of yourself, not the rest of yourself.”

What are some areas in a relationship that cause couples to go off track when it comes to romantic love?

One area is relationship boundaries. A boundary is any line that sets a limit. No one is born with automatic boundaries. They are developed over time and many enter adulthood with broken and damaged boundaries. Research shows that abuse, humiliation, shame and some mental disorders negatively affect the development of a healthy loving relationship. Our boundaries determine how we bond with others and, if we have broken boundaries, we become vulnerable to sabotage by others. It is our responsibility to develop boundaries and adjust them as needed throughout our lifetime.

One therapeutic exercise I use to teach people about boundaries is having them say “no” to something asked of them that they think or feel obligated to say “yes.” By saying “no,” it eliminates the role of victim and helps set a boundary.

Another area to examine is codependency, which is the control, nurturing and maintenance of relationships with individuals who are chemically dependent or engaging in undesirable behaviors. A classic codependency model is the alcoholic husband and the enabling wife. This model exemplifies the saying “when there is ongoing conflict, there is underlying agreement…” in other words, “it takes two to tango.”

Codependent people with weak boundaries are experts at tolerance for mental and physical pain. It becomes difficult for them to notice that someone is hurting them or that they are hurting themself.

Recovery from codependency, as well as learning to set boundaries in a relationship, is achievable and can help restore romantic love — positive change is always possible.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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THE THERAPY ROOM: All about New Year’s resolutions

Posted on 18 January 2018 by LeslieM

A New Year’s resolution has become a tradition or even a ritual by which a person resolves to change an undesired trait or behavior to accomplish a personal goal or otherwise improve their life beginning the first day of the New Year.

Over half of us make New Year’s resolutions, but less than 20 percent of us succeed at making them a reality. It may reflect a lack of motivation, lack of resources or just losing interest. Isn’t it time we figure out practical ways to actually accomplish bringing our resolutions to fruition?

The most common New Year’s resolutions I have heard as a psychotherapist include the following:

Weight loss and exercising

Learning something new

Investing money rather than just spending it

Being kinder to oneself and others

Searching for a new job

Volunteering

Reducing or eliminating alcohol consumption

Acquiring better sleeping habits

Meeting new friends and be a better friend

More than 80 percent of us who make New Year’s resolutions do not accomplish them. Why?

Many of us make New Year’s resolutions that are simply not attainable. Did you commit to something you truly want to commit to or did you think it is something you must commit to? Slow down and stop focusing on what others have suggested for you to accomplish and be mindful of what you want for yourself and plan a strategy to achieve it.

If you are someone who does better and feels better with a support system, get someone to join you or be there for you as you lose weight, eat better, reduce or stop drinking alcohol, or work out at the gym. This is a way for you to be accountable to achieve your goals, and being accountable is essential for your success.

Surrendering can sabotage a New Year’s resolution. You may get discouraged or lose interest, so try journaling to monitor your progress throughout the year. Keeping yourself on track will provide the motivation needed for your ultimate success.

Time management is important. Rather than trying to accomplish all in one day or one week, break your strategic plan into smaller parts. Dedicate five to 10 minutes a day doing crunches or jogging versus an hour daily. Five to 10 manageable minutes will make what you are doing a habit and that will help you to move forward.

If you resolve to lose weight and consider joining a high-end health club, you may wind up anxious from the thought of the expense and avoid joining any health facility. There are more ways to exercise and lose weight than using an expensive health club. Visit your local YMCA/YWCA or place of worship that has group exercise programs that cost less. Consider setting up a home gym or see what your neighborhood recreational park facility may have to offer. Financial burdens will only help you lose interest fast in any of your New Year’s resolutions.

I want you to believe in yourself and the New Year’s resolutions you are striving for in 2018. Be kind to yourself and others and you will achieve your goals. Meaningful change is possible.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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The Therapy Room: Winter Holiday Survival Tips for Anxiety and Depression

Posted on 21 December 2017 by LeslieM

The Therapy Room: Winter Holiday Survival Tips for Anxiety and Depression

The winter holidays cause many to experience unwanted stress, anxiety and depression. Many factors trigger such reactions and include unrealistic expectations of self and others, financial pressures, making too many commitments to family, co-workers and friends, and, sometimes, even focusing on the inability to be with those you believe you would prefer to be with.

Certain individuals feel anxious or depressed around the winter holidays due to seasonal affective disorder (SAD), which is also referred to as seasonal depression. SAD is a kind of depression that tends to occur as daylight grows shorter in the fall and winter months and, therefore, is a result of inadequate exposure to sunlight.

The symptoms of SAD include tiredness, fatigue, sadness, irritability, poor concentration, muscular pain, insomnia, appetite changes, excessive alcohol consumption, social isolation and loneliness. Lifestyle changes that are proven to decrease SAD symptoms include spending more time outdoors, exercising and maintaining healthy eating habits. Psychotherapy, light therapy, acupuncture and medications are additional options to consider to decrease SAD symptoms.

Organizing and balancing the demands of holiday gifts and food shopping, family obligations, social gathering events and even house guests contribute to feelings of stress, anxiety, being overwhelmed and increased tension.

If someone dismisses depression, they may actually develop stress responses and experience physical and emotional symptoms, such as headaches, over-eating, insomnia or excessive alcohol consumption. Some individuals also experience anxiety and depression after the New Year due to high expectations leading to extreme disappointments.

Many of us think about loved ones who have passed away during the winter holidays. Love does not end in death and it is important that we keep such loved ones alive by the way we live. Include memories of them during your holiday gatherings and celebration by decorating a wreath with items that remind you of them, display happy memory pictures, make their favorite dish for your family and friends to enjoy, or light a candle and reflect on the light they continue to bring to your life.

For those suffering from winter holiday anxiety or depression, benefits may be realized by increasing social support, asking for help and sharing family holiday responsibilities, such as food shopping and preparation, maintaining a budget for gift purchases and making, and taking, time to relax. Psychotherapy and support groups can help you gain insight into your holiday blues, relieve stress and bring a layer of needed social support.

Tips to prevent stress, anxiety and depression during the winter holidays:

Set realistic goals and make realistic expectations

Do not take on more responsibilities than you can manage — delegate!

Do not set yourself up for disappointment and sadness

Volunteer and help others — you will be helping yourself as well!

Limit or do not drink alcohol — excessive alcohol consumption increases feelings of depression

Reach out and make new friends — spend time with supportive people

Winter holidays bring anxiety and depression into many lives and can be managed by implementing the above tips. Also consider seeking individual psychotherapy or group support if these symptoms become overwhelming and too much of a burden. This winter holiday season make time for yourself and consider doing something new — change is possible!

Dr. Julia Breur, Ph. D., LMFT is a licensed marriage and family therapist with a private clinical psychotherapy practice in Boca Raton, Florida. Further information available at www.drjuliabreur.com.

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The Therapy Room: Exercise: Become Stronger, Smarter and Younger

Posted on 16 November 2017 by LeslieM

Why do Americans spend billions of dollars annually on elixirs and quick fixes to look better? Does any medicine exist today that can make us stronger, smarter and younger? The miracle medicine that truly works and can provide longevity, health and wellness is EXERCISE.

Our country is trying to untangle and reassemble the current healthcare system into one that works. There are many changes that must take place and I believe more emphasis must be placed on the many health benefits of exercise — for all ages!

The consequences of a sedentary lifestyle have been well studied and researched. People who do not or rarely exercise are at risk for various cancers, heart disease, chronic diseases, depression, and other mental and physical health issues. The National Institutes of Health recently launched a study aimed at what exactly happens to a human body that moves. The goal is to prove that exercise is the ultimate medicine.

Not every type of exercise works for every person. An effective way to make exercise more desirable is to incorporate a goal-orientated approach. I do this in my psychotherapy private practice. I promote brief therapy with specific goals spelled out clearly and carried forward for each of my patients. Achieving mental and physical health goals motivates my patients to move forward and achieve their goals.

Here are a few reasons why you should exercise:

Doing any exercise 3-4 times a week for 20-30 minutes will increase your energy and stamina.

Walking daily and monitoring your steps using a fitness tracking device will improve your health. Any number over zero is improvement, but 7,000-10,000 steps a day will help reduce visits to the doctor.

Exercising will ease symptoms of many chronic conditions. Consider meeting with a professional trainer to build strength and endurance and to reduce pain by increasing blood flow and releasing endorphins — those feel good brain chemicals.

Exercising will help you to lose weight. You will become conscious of the nutritional content and portion size of the food you eat. Strength training and cardiovascular exercises will ultimately help you to attain the body and overall health you desire.

Exercising reduces anxiety and depression. Move your body and do something different because sitting and watching television, or using devices for long periods of time can lead to stress. Take a walk, swim in the ocean, consider a spin or yoga class. Just move your body and your thinking will improve!

The strongest evidence that exercise is key to being youthful is that studies consistently show that people who exercise regularly have fewer strokes, fewer heart attacks and live longer than those who stay put. Your body in motion slows down the acceleration of aging at the cellular level. Why not consider exercising to feel and look better and stronger? Make your move today — change is possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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The Therapy Room: Bullying: Bullies, victims and bully-victims

Posted on 19 October 2017 by LeslieM

Bullying has existed since the beginning of time. This is the digital age and today bullying no longer simply happens in one’s personal space. One can be cyber-bullied from thousands of miles away over the Internet using e-mail or text messaging, or using Twitter, Facebook, Instagram, and many other Internet sites. With so many ways to bully others, it is getting more difficult than ever to control it, and to protect and save victims. What exactly is bullying, who are bullies and what are their motivations, and why are certain individuals targeted? Let’s explore these questions.

Let’s define bullying:

It is unwanted, aggressive and repetitive behavior that involves a real or perceived power imbalance, such as physical strength or access to private, or embarrassing, information to control or harm an individual. Bullying includes actions such as threats, spreading rumors, attacking someone physically or verbally, and purposely excluding someone from a group.

Three types of bullying:

Verbal: Saying or writing mean things by teasing, name-calling, saying inappropriate sexual comments, or taunting and threatening to harm.

Physical: Hurting a person’s body or possessions by hitting, kicking, pinching, tripping, pushing, spitting, breaking someone’s possessions and making inappropriate hand gestures.

Social or relational: Hurting someone’s reputation or relationships by leaving someone out of a group activity, telling others not to be friends with someone, spreading rumors and publicly embarrassing someone.

Who is the bully?

Bullies come from all walks of life, all ages, genders, races and from all parts of the world. Bullies are often people who have been bullied or abused themselves, and turn to being powerful using fear tactics as a way to gain respect from people who look up to them. There are also new studies that show that bullies have excellent self-esteem and usually have a sense of entitlement, and lack social skills and impulse control.

Who are the victims?

People who bully tend to look for victims over whom they believe they have power. Bullies pick on others who are shy, socially isolated, insecure or different in the way they look or act compared to the norm.

No one deserves to be bullied and many victims feel shame or embarrassment that they have been bullied, so often try to hide it. The victims of bullying often feel badly and see themselves as deserving of the bully’s attention.

Who is the bully-victim?

Some individuals fit both the role of bully and victim and are defined as such. Generally, from a behavioral and emotional point of view, bullies experience behavioral issues; victims experience emotional issues; bully-victims experience both behavioral and emotional issues. Studies show that the bully-victim generally experiences the most problems and has the highest risk of adverse outcomes.

What can we all do?

If a person is being bullied, they should tell someone, such as a parent, a teacher or a police officer. The person being told must then take action to stop the behavior. Psychotherapy can help get to the root of the issue and help the victim recover, and help the bully change their actions and behavior.

Bullying is a serious issue and must be stopped, as it has proven to have lasting psychological effects on the victims and the bullies as well. There is help for victims, bullies and anyone who knows that bullying is going on. Do not be a bystander; it is everyone’s responsibility to help stop bullying – change is possible! For more information, go to www.stopbullying.gov.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further Information is available at www.drjuliabreur.com.

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THE THERAPY ROOM: Hurricane Irma and the stress and anxiety we experience

Posted on 14 September 2017 by LeslieM

Before making landfall in Florida, Hurricane Irma broke records on its relentless churn through the Caribbean. Irma spent 8.5 days as a major hurricane and sustained 185 mph winds for 37 hours as a Category 5 hurricane — making it the longest cyclone on the globe to maintain such intensity. Irma was the strongest storm that has ever existed in the Atlantic outside the Caribbean and Gulf of Mexico. Irma will break more records and will be with us in many ways, such as through flooding issues, wind damage, power outages, structural damage and destruction to homes, businesses, vegetation, pets, farm animals, vehicles, boats, bridges and roadways.

A high percentage of those living or working in the path of this hurricane, which happened to be the entire state of Florida, experienced stress and anxiety when planning a strategy to deal with the onset and then fall out of this force of nature.

The American Psychological Association states that it is common for people to experience very strong emotional reactions with the arrival of a hurricane and its accompanying damage to homes and community infrastructures. Understanding common responses to extreme events can help you to cope effectively with your feelings, thoughts and behaviors.

Here are steps one can take to help restore emotional well-being and a sense of control in the wake of Hurricane Irma:

Recognize and manage: You have tackled hardships at other times in your life. Tap into the skills you used to get through past challenges.

Network TV and online news: Watching replays of footage from the hurricane can make your stress even greater. Often, the media tries to interest viewers by presenting worst case scenarios and they may not be representative of your home or community.

Ask for and get support: Reach out to people who care about you and who will listen and empathize with your situation. Find out about local support groups led by trained and experienced professionals.

Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest. If you experience difficulties sleeping, you may be able to find some relief through relaxation techniques. Avoid alcohol and drugs since these can increase a sense of depression and/or impede you from doing what is necessary to be resilient and cope with events.

Individuals with prolonged distress related to Irma that disrupt their daily functioning should consider consulting with a trained and experienced mental health professional to help provide education about best responses to extreme stress and create a plan for moving forward.

As you gather with family, friends and co-workers in the days and months ahead for special events, or to celebrate holidays, reflect on what Hurricane Irma may have taught you and then hold onto those you love a little tighter, and listen with kindness to those you may disagree with in order to find common ground or initiate compromise. The devastation caused by Hurricane Irma helps us acknowledge how precious life is and it can also help us better demonstrate to our self and others an appreciation for this beautiful, amazing and challenging life we have. Change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.

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The Therapy Room: Chronic Pain

Posted on 17 August 2017 by LeslieM

The United States of America is experiencing a national opioid addiction crisis; the use of opioid pain medications has reached epidemic proportions! Those who suffer with chronic pain, defined as any pain lasting more than 12 weeks, and who take opioid medications, are monitored more than ever before by medical professionals who prescribe and dispense them. Monitoring those taking pain medications is important to prevent overdosing and opioid side effects, such as drowsiness, nausea and vomiting. It is important to also look for signs of drug misuse, the development of intolerance and addiction.

Opioid medications include codeine, fentanyl, hydrocodone, hydrocodone/acetaminophen, hydromorphone, meperidine, methadone, morphine, oxycodone, oxycodone/acetaminophen and oxycodone/naloxone. Many medical experts today debate if opioids effectively treat chronic pain and recommend non-opioid pain medications to their patients, such as acetaminophen, ibuprofen, anticonvulsants, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants and topical NSAIDs.

How can someone realize they are becoming dependent or addicted to pain medication? Here are questions to help and, if the answer is “yes” to one or more of these questions, it is recommended one contact a medical professional for further help:

Do you take more pain medication than prescribed?

Do you get pain medications from friends and family versus your pharmacist?

Do you get pain prescriptions from more than one doctor?

In addition to taking pain medication for your chronic pain, do you also take same medication to treat a bad mood, anxiety or to sleep?

Do you spend more time than you should worrying about running out of your pain medication?

Psychotherapy is an excellent collaborative treatment for anyone with chronic pain and/or taking pain medications. As a clinical psychotherapist, I see many patients with chronic pain and after I attain details on the type of chronic pain they experience and medications used I focus on how they respond to their pain. Do they respond to their pain with distressing thoughts that ruminate and magnify pain, along with feelings of helplessness about their chronic pain.  This response to chronic pain is defined as pain catastrophizing and it relates to any depression and anxiety being experienced. Studies show that people who catastrophize have more severe pain, require more pain medication and have reduced response to multidisciplinary pain care. 

Psychotherapy can provide much needed education and relief to a person’s experience with chronic pain.

In addition to psychotherapy, other treatments for chronic pain include chiropractic care, nutritional counseling, weight management, acupuncture, pressure point therapy, salt therapy, biofeedback, meditation, oga, Pilates and various exercise and wellness programs.

A psychotherapy client of mine experiences physical pain from multiple sclerosis and diabetes. If her workday starts in pain, she focuses on making it to lunch time and then maybe treating herself to a frozen yogurt. The simple act of getting through the day by taking small steps and rewarding herself with a treat helps her to manage her chronic pain.

Another psychotherapy client chooses to get off his reclining chair and go for a walk on the beach and breathe in the salt-filled ocean air. He believes that modifying his surroundings and physically moving are solutions to managing his chronic pain and he wants others to know that change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further Information available at www.drjuliabreur.com.

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The Therapy Room: Hoarding

Posted on 19 July 2017 by LeslieM

By Julia Breur, Ph.D., LMFT

Hoarding disorder is defined by the Diagnostic Statistical Manual of Mental Disorders (DSM-5) as the persistent difficulty discarding or parting with possessions, regardless of their actual value.

Hoarding was considered a form of obsessive-compulsive disorder (OCD) until recently when the American Psychiatric Association recognized hoarding as its own disorder.

This disorder affects both males and females, but epidemiological studies report a significantly greater prevalence among males. This contrasts with clinical samples, which are predominantly female. Hoarding symptoms appear to be almost three times more prevalent in older adults, ages 55-94 years compared with younger adults ages 34-44 years.

Difficulty and distress comes into a hoarding individual’s world when there is a need to discard possessions or the accumulation of possessions that congest and clutter living areas and compromise their intended use. These individuals may not see their hoarding behavior and their collected items as a problem, making any treatment challenging. Hoarding is also known to cause depression, anxiety, anger and resentment among a hoarding individual’s family members.

Compulsive buying, the compulsive acquisition of free items and even the compulsive search for perfect or unique items is part of hoarding. Individuals with this disorder believe that an item will be useful or valuable in the future, has sentimental value, is unique and irreplaceable, or is too big a bargain to throw away. They may also consider an item a reminder that will jog their memory, thinking that without it they won’t remember an important person or event. Sometimes they can’t decide where something belongs and think it’s better just to keep it. Hoarded items usually include paper products, such as newspapers, magazines, boxes and photographs, along with grocery items, food and clothing. Some individuals also hoard animals.

Hoarding is very different than collecting. In general, collectors have a sense of pride about their possessions and they experience joy in displaying and talking about them. They usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money. Those who hoard usually experience embarrassment about their possessions and feel uncomfortable when others see them. They have clutter, often at the expense of livable space, feel sad or ashamed after acquiring additional items, and they are often in debt.

Many individuals live with broken appliances and without proper air ventilation and other living conditions of comfort. They cope with malfunctioning systems rather than allow a qualified person into their home to fix a problem. Unlivable conditions that are a result of hoarding are known to lead to divorce, eviction, loss of child custody and serious financial issues.

To assist in the recovery of a person who hoards, engage with care and compassion. Point out the risks and safety concerns, such as fire hazards, and slipping and falling potentials, versus accenting blame and shame. Develop a small step by small step strategy and, as key milestones are achieved, encourage and point out accomplishments being made. Many hoarding individuals have organizational challenges and you can help by enhancing concrete skills such as use of a calendar, time management and setting goals. Hoarding information, resources and support for families, friends, spouses and the hoarding individual can be found at childrenofhoarders.org

A&E’s television show, Hoarders and TLC’s television series Hoarding: Buried Alive have brought this disorder into greater public awareness and discussion. Physicians, researchers and psychotherapists continue to develop new and effective hoarding treatment plans and, with an active and flexible support system in place, change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton, FL. For more information, visit www.drjuliabreur.com.

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